GRADE equity guidelines 3: considering health equity in GRADE guideline development: rating the certainty of synthesized evidence.

Academic Article


  • OBJECTIVES: The aim of this paper is to describe a conceptual framework for how to consider health equity in the Grading Recommendations Assessment and Development Evidence (GRADE) guideline development process. STUDY DESIGN AND SETTING: Consensus-based guidance developed by the GRADE working group members and other methodologists. RESULTS: We developed consensus-based guidance to help address health equity when rating the certainty of synthesized evidence (i.e., quality of evidence). When health inequity is determined to be a concern by stakeholders, we propose five methods for explicitly assessing health equity: (1) include health equity as an outcome; (2) consider patient-important outcomes relevant to health equity; (3) assess differences in the relative effect size of the treatment; (4) assess differences in baseline risk and the differing impacts on absolute effects; and (5) assess indirectness of evidence to disadvantaged populations and/or settings. CONCLUSION: The most important priority for research on health inequity and guidelines is to identify and document examples where health equity has been considered explicitly in guidelines. Although there is a weak scientific evidence base for assessing health equity, this should not discourage the explicit consideration of how guidelines and recommendations affect the most vulnerable members of society.
  • Published In


  • Applicability, GRADE, Guidelines, Health, Indirectness, Meta-analysis, Subgroup analysis, Systematic review, equity, Evidence-Based Practice, Health Equity, Humans, Meta-Analysis as Topic, Practice Guidelines as Topic, Research Design, Review Literature as Topic, Vulnerable Populations
  • Digital Object Identifier (doi)

    Author List

  • Welch VA; Akl EA; Pottie K; Ansari MT; Briel M; Christensen R; Dans A; Dans L; Eslava-Schmalbach J; Guyatt G
  • Start Page

  • 76
  • End Page

  • 83
  • Volume

  • 90